Introduction
Materials and methods
Study population
Characteristics | dNENs (n = 22) | dGISTs (n = 54) | P value* |
---|---|---|---|
Age (year) | 58.73 ± 9.886 | 57.56 ± 11.58 | 0.841 |
Gender | 0.017 | ||
Male | 16 (72.7) | 23 (42.6) | |
Female | 6 (27.3) | 31 (57.4) | |
Cardinal symptoms | 0.017 | ||
Abdominal discomfort, pain, or bloating | 11 (50.0) | 12 (22.2) | |
Gastrointestinal bleeding (hematochezia, pale complexion, anemia) | 3 (13.6) | 24 (44.4) | |
Other symptoms or asymptomatic | 8 (36.4) | 18 (33.3) | |
Surgery modality | NA | ||
Pancreatoduodenectomy/whipple surgery | 7 (31.8) | 7 (13.0) | |
Duodenal mass resection with subtotal gastrectomy | 2 (9.1) | 9 (16.7) | |
Limited resectiona | 7 (31.8) | 33 (61.1) | |
Palliative surgery | 1 (4.5) | 0 (0) | |
Endoscopic resection | 3 (13.6) | 1 (1.9) | |
Biopsy modality | NA | ||
(Ultrasound-guided) endoscopic biopsy | 2 (9.1) | 3 (5.6) | |
Laparoscopic duodenal mass biopsy | 0 (0) | 1 (1.9) | |
Largest tumor diameter (cm) | 35.72 ± 23.47 | 37.99 ± 19.77 | 0.419 |
Location | 0.257 | ||
Bulb | 9 (40.9) | 14 (25.9) | |
Descending | 7 (31.8) | 13 (24.1) | |
Horizontal | 5 (22.7) | 17 (31.5) | |
Ascending | 1 (4.5) | 10 (18.5) | |
Growth pattern | < 0.001 | ||
Intraluminal | 13 (59.1) | 8 (14.8) | |
Extraluminal | 5 (22.7) | 12 (22.2) | |
Mixed | 4 (18.2) | 34 (63.0) | |
Contour | 0.639 | ||
Round/ovoid | 9 (40.9) | 19 (35.2) | |
Irregular/lobulated | 13 (59.1) | 35 (64.8) | |
Morphology | 0.098 | ||
Mass | 18 (81.8) | 52 (96.3) | |
Wall thickening with/without mass | 4 (18.2) | 2 (3.7) | |
Ulceration | 0.242 | ||
Presence | 2 (9.1) | 13 (24.1) | |
Absence | 20 (90.9) | 41 (75.9) | |
Tumor texture | 0.263 | ||
Solid | 14 (63.6) | 41 (75.9) | |
Solid and cystic | 6 (27.3) | 12 (22.2) | |
Complex cystic | 2 (9.1) | 1 (1.9) | |
Rim enhancement | > 0.999 | ||
Presence | 3 (13.6) | 8 (14.8) | |
Absence | 19 (86.4) | 46 (85.2) | |
Hemorrhage | > 0.999 | ||
Presence | 0 (0) | 2 (3.7) | |
Absence | 22 (100) | 52 (96.3) | |
Calcification | 0.501 | ||
Presence | 1 (4.5) | 7 (13.0) | |
Absence | 21 (95.5) | 47 (87.0) | |
Border | 0.138 | ||
Well-defined | 17 (77.3) | 50 (92.6) | |
Ill-defined | 5 (22.7) | 4 (7.4) | |
Lymph node metastases | 0.128 | ||
Presence | 3 (13.6) | 1 (1.9) | |
Absence | 19 (86.4) | 54 (98.1) | |
Liver metastases | 0.199 | ||
Presence | 2 (9.1) | 1 (1.9) | |
Absence | 20 (90.9) | 53 (98.1) | |
Feeding arteries | 0.272 | ||
Presence | 10 (45.5) | 32 (59.3) | |
Absence | 12 (54.5) | 22 (40.7) | |
Intratumoral vessels | < 0.001 | ||
Presence | 8 (36.4) | 45 (83.3) | |
Absence | 14 (63.6) | 9 (16.7) | |
Draining veins | < 0.001 | ||
Presence | 9 (40.9) | 44 (81.5) | |
Absence | 13 (59.1) | 10 (18.5) | |
CT value of unenhanced lesion (HU) | 41.09 ± 2.83 | 39.46 ± 1.90 | 0.002 |
Arterial lesion enhancement (HU) | 116.57 ± 32.52 | 114.49 ± 28.47 | 0.909 |
Portal lesion enhancement (HU) | 114.05 ± 23.14 | 110.16 ± 19.68 | 0.506 |
Enhancement in the portal phase | 0.265 | ||
Isoenhancement | 12 (54.5) | 23 (42.6) | |
Washout | 5 (22.7) | 13 (24.1) | |
Sustained enhancement | 5 (22.7) | 10 (18.5) | |
Mixed enhancement | 0 (0) | 8 (14.8) | |
Arterial absolute enhancement | 75.48 ± 32.08 | 74.84 ± 28.16 | 0.973 |
Portal absolute enhancement | 72.96 ± 23.33 | 70.51 ± 19.24 | 0.740 |
Arterial relative enhancement ratio | 1.84 ± 0.78 | 1.89 ± 0.71 | 0.663 |
Portal relative enhancement ratio | 1.79 ± 0.60 | 1.78 ± 0.48 | > 0.999 |
Enhancement grade | 0.699 | ||
Mild | 0 (0) | 1 (1.9) | |
Moderate | 2 (9.1) | 2 (3.7) | |
Strong | 20 (90.9) | 51 (94.4) | |
Enhancement pattern | 0.017 | ||
Heterogeneous | 11 (50.0) | 42 (77.8) | |
Homogeneous | 11 (50.0) | 12 (22.2) |
CT imaging acquisition
Image analysis
Statistical analysis
Results
Comparing clinical information and CT features between non-ampullary dNENs and dGISTs
Establishing a diagnostic model for tumor differentiation
Variables | B | P* | OR | 95% CI for OR | |
---|---|---|---|---|---|
Lower | Upper | ||||
Growth pattern | − 0.800 | 0.045 | 0.450 | 0.206 | 0.983 |
Intratumoral vessels | − 1.573 | 0.023 | 0.207 | 0.053 | 0.807 |
Unenhanced lesion > 40.76 HU | 1.744 | 0.008 | 5.720 | 1.575 | 20.774 |
Baseline data and survival outcomes of patients with dNENs
Characteristics | Total (n = 44) | G1/2 (n = 25) | G3/NEC (n = 19) | P value* | Cutoff value |
---|---|---|---|---|---|
Age (year) | 61.11 ± 10.22 | 59.32 ± 10.10 | 63.47 ± 10.15 | 0.162 | 66 |
Gender | 0.343 | ||||
Male | 29 (65.9) | 15 (60.0) | 14 (73.7) | ||
Female | 15 (34.1) | 10 (40.0) | 5 (26.3) | ||
Median survival time (m) | 61 | 68 | 11 | < 0.001 | |
Cardinal symptoms | < 0.001 | ||||
Diarrhea or emesis | 4 (9.1) | 4 16.0) | 0 (0) | ||
Abdominal discomfort, pain, or bloating | 17 (38.6) | 9 (36.0) | 8 (42.1) | ||
Obstructive jaundice (yellow urine, icterus, clay stool) | 7(15.9) | 0 (0) | 7 (36.8) | ||
Gastrointestinal bleeding (hematochezia, pale complexion, anemia) | 4 (9.1) | 416.0) | 0 (0) | ||
Asymptomatic | 12 (27.3) | 8 (32.0) | 4 21.1) | ||
Surgery modality | NA | ||||
Pancreatoduodenectomy/whipple surgery | 21 (47.7) | 11 (44.0) | 10 (52.6) | ||
Duodenal mass resection with subtotal gastrectomy | 2 (4.5) | 2 (8.0) | 0 (0) | ||
Limited resectiona | 7 (15.9) | 7 (28.0) | 0 (0) | ||
Palliative surgery | 3 (6.8) | 0 (0) | 2 (5.3) | ||
Endoscopic resection | 2 (4.5) | 3 (12.0) | 0 (0) | ||
Biopsy modality | NA | ||||
(Ultrasound-guided) endoscopic biopsy | 8 (18.2) | 2 (8.0) | 6 (31.6) | ||
Supraclavicular lymphadenopathy biopsy | 1 (2.3) | 0 (0) | 1 (5.3) | ||
Largest tumor diameter (cm) | 31.62 ± 19.67 | 27.32 ± 13.58 | 37.27 ± 24.89 | 0.139 | 26.6 |
Location 1 | 0.209 | ||||
Bulb | 9 (20.5) | 7 (28.0) | 2 (10.5) | ||
Descending | 25 (56.8) | 11 (44.0) | 14 (73.7) | ||
Horizontal | 9 (20.5) | 6 (24.0) | 3 (15.8) | ||
Ascending | 1 (2.3) | 1 (4.0) | 0 (0) | ||
Location 2 | 0.001 | ||||
Peri-/ampullary | 22 (50.0) | 7 (28.0) | 15 (78.9) | ||
Non-ampullary | 22 (50.0) | 18 (72.0) | 4 (21.1) | ||
Growth pattern | 0.031 | ||||
Intraluminal | 31 (70.5) | 18 (72) | 13 (68.4) | ||
Extraluminal | 5 (11.4) | 5 (20.0) | 0 (0) | ||
Mixed | 8 (18.2) | 2 (8.0) | 6 (31.6) | ||
Contour | 0.066 | ||||
Round/ovoid | 16 (36.4) | 12 (48.0) | 4 (21.1) | ||
Irregular/lobulated | 28 (63.6) | 13 (52.0) | 15 (78.9) | ||
Morphology | 0.219 | ||||
Mass | 37 (84.1) | 23 (92.0) | 14 (73.7) | ||
Wall thickening with/without mass | 7 (15.9) | 2 (8.0) | 5 (26.3) | ||
Ulceration | 0.107 | ||||
Presence | 8 (18.2) | 2 (8.0) | 6 (31.6) | ||
Absence | 36 (81.8) | 23 (92.0) | 13 (68.4) | ||
Tumor texture | 0.403 | ||||
Solid | 32 (72.7) | 19 (76.0) | 13 (68.4) | ||
Solid and cystic | 10 (22.7) | 4 (16.0) | 6 (31.6) | ||
Complex cystic | 2 (4.5) | 2 (8.0) | 0 (0) | ||
Rim enhancement | 0.337 | ||||
Presence | 41 (93.2) | 22 (88.0) | 19 (100) | ||
Absence | 3 (6.8) | 3 (12.0) | 0 (0) | ||
Hemorrhage | > 0.999 | ||||
Presence | 1 (2.3) | 1 (4.0) | 0 (0) | ||
Absence | 43 (97.7) | 24 (96.0) | 19 (100) | ||
Calcification | > 0.999 | ||||
Presence | 2 (4.5) | 1 (4.0) | 1 (5.3) | ||
Absence | 42 (95.5) | 24 (96.0) | 18 (94.7) | ||
Border | < 0.001 | ||||
Well-defined | 22 (50.0) | 21 (84.0) | 1 (5.3) | ||
Ill-defined | 22 (50.0) | 4 (16.0) | 18 (94.7) | ||
Obstructive biliary and/or pancreatic duct dilation | < 0.001 | ||||
Presence | 19 (43.2) | 5 (20.0) | 14 (73.7) | ||
Absence | 25 (56.8) | 20 (80.0) | 5 (26.3) | ||
Cut off suddenly of the common bile dilation | < 0.001 | ||||
Presence | 15 (34.1) | 3 (12.0) | 12 (63.2) | ||
Absence | 29 (65.9) | 22 (88.0) | 7 (36.8) | ||
Lymph node metastases | < 0.001 | ||||
Presence | 19 (43.2) | 3 (12.0) | 16 (84.2) | ||
Absence | 25 (56.8) | 22 (88.0) | 3 (15.8) | ||
Liver metastases | 0.219 | ||||
Presence | 7 (15.9) | 2 (8.0) | 5 (26.3) | ||
Absence | 37 (84.1) | 23 (92.0) | 14 (73.7) | ||
Feeding arteries | 0.976 | ||||
Presence | 14 (31.8) | 8 (32.0) | 6 (31.6) | ||
Absence | 30 (68.2) | 17 (68.0) | 13 (68.4) | ||
Intratumoral vessels | 0.143 | ||||
Presence | 17 (38.6) | 12 (48.0) | 5 (26.3) | ||
Absence | 27 (52.0) | 13 (52.0) | 14 (73.7) | ||
Draining veins | 0.47 | ||||
Presence | 14 (31.8) | 11 (44.0) | 3 (15.8) | ||
Absence | 30 (68.2) | 14 (56.0) | 16 (84.2) | ||
CT value of unenhanced lesion (HU) | 41.04 ± 2.56 | 41.35 ± 2.88 | 40.64 ± 2.08 | 0.314 | 40.29 |
Arterial lesion enhancement (HU) | 100.31 ± 32.51 | 112.96 ± 31.48 | 83.67 ± 26.26 | < 0.001 | 85.33 |
Portal lesion enhancement (HU) | 107.42 ± 21.07 | 116.54 ± 19.89 | 95.42 ± 16.28 | 0.001 | 99.79 |
Enhancement in the portal phase | 0.388 | ||||
Isoenhancement | 18 (40.9) | 10 (40.0) | 8 (42.1) | ||
Washout | 6 (13.6) | 5 (20.0) | 1 (5.3) | ||
Sustained enhancement | 20 (45.5) | 10 (40.0) | 10 (52.6) | ||
Mixed enhancement | 0 (0) | 0 (0) | 0 (0) | ||
Arterial absolute enhancement | 59.27 ± 32.37 | 71.61 ± 31.47 | 43.03 ± 26.33 | 0.001 | 42.2 |
Portal absolute enhancement | 66.38 ± 20.90 | 75.19 ± 20.09 | 54.78 ± 15.99 | 0.001 | 63.02 |
Arterial relative enhancement ratio | 1.45 ± 0.81 | 1.74 ± 0.78 | 1.06 ± 0.69 | 0.001 | 1.06 |
Portal relative enhancement ratio | 1.62 ± 0.52 | 1.83 ± 0.52 | 1.35 ± 0.39 | 0.002 | 1.61 |
Enhancement pattern | 0.020 | ||||
Heterogeneous | 26 (59.1) | 11 (44.0) | 15 (78.9) | ||
Homogeneous | 18 (40.9) | 14 (56.0) | 4 (21.1) |
Univariate and multivariate Cox regression analysis of the study population
Variables | Univariate analyses | |
---|---|---|
HR (95% CI) | P value | |
Grade | ||
G1/2 | 1.000 | |
G3/NECs | 20.279 (4.564–90.104) | < 0.001 |
Age (year) | ||
≤ 66 | 1.000 | |
> 66 | 0.526 (0.212–1.305) | 0.166 |
Gender | ||
Female | 1.000 | |
Male | 3.716 (1.050–13.146) | 0.042 |
Cardinal symptoms | ||
Other symptoms or asymptomatic | 1.000 | |
Obstructive jaundice (yellow urine, icterus, clay stool) | 4.339 (1.433–13.134) | 0.009 |
Largest tumor diameter (cm) | ||
≤ 26.6 | 1.000 | |
> 26.6 | 3.031 (1.064–8.634) | 0.038 |
Location | ||
Non-ampullary | 1.000 | |
Peri-/ampullary | 4.985 (1.625–15.290) | 0.005 |
Contour | ||
Round/ovoid | 1.000 | |
Irregular/lobulated | 4.264 (1.236–14.709) | 0.022 |
Morphology | ||
Mass | 1.000 | |
Wall thickening with/without mass | 2.465 (0.933–6.515) | 0.069 |
Ulceration | ||
Absence | 1.000 | |
Presence | 2.959 (1.154–7.590) | 0.024 |
Rim enhancement | ||
Absence | 1.000 | |
Presence | 0.043 (0.000–69.276) | 0.403 |
Calcification | ||
Absence | 1.000 | |
Presence | 3.294 (0.396–27.362) | 0.270 |
Border | ||
Well-defined | 1.000 | |
Ill-defined | 31.321 (4.152–236.279) | 0.001 |
Obstructive biliary and/or pancreatic duct dilation | ||
Absence | 1.000 | |
Presence | 5.075 (1.903–13.535) | 0.001 |
Cut off suddenly of the common bile dilation | ||
Absence | 1.000 | |
Presence | 5.692 (2.101–15.419) | 0.001 |
Lymph node metastases | ||
Absence | 1.000 | |
Presence | 18.722 (4.281, 81.876) | < 0.001 |
Liver metastases | ||
Absence | 1.000 | |
Presence | 3.344 (1.245–8.980) | 0.017 |
Feeding arteries | ||
Absence | 1.000 | |
Presence | 1.128 (0.414–3.068) | 0.814 |
Intratumoral vessels | ||
Absence | 1.000 | |
Presence | 0.852 (0.321–2.261) | 0.747 |
Draining veins | ||
Absence | 1.000 | |
Presence | 0.346 (0.100–1.196) | 0.094 |
CT value of unenhanced lesion (HU) | ||
> 40.29 | 1.000 | |
≤ 40.29 | 0.994 (0.390–2.533) | 0.990 |
Arterial lesion enhancement (HU) | ||
> 85.33 | 1.000 | |
≤ 85.33 | 6.457 (2.419–17.235) | < 0.001 |
Portal lesion enhancement (HU) | ||
> 99.79 | 1.000 | |
≤ 99.79 | 3.655 (1.430–9.338) | 0.007 |
Arterial absolute enhancement | ||
> 42.2 | 1.000 | |
≤ 42.2 | 6.457 (2.419–17.235) | < 0.001 |
Portal absolute enhancement | ||
> 63.03 | 1.000 | |
≤ 63.02 | 3.368 (1.273–8.910) | 0.014 |
Arterial relative enhancement ratio | ||
> 1.06 | 1.000 | |
≤ 1.06 | 6.098 (2.277–16.335) | < 0.001 |
Portal relative enhancement ratio | ||
> 1.61 | 1.000 | |
≤ 1.61 | 2.984 (0.983–9.059) | 0.054 |
Enhancement pattern | ||
Homogeneous | 1.000 | |
Heterogeneous | 4.708 (1.364–16.245) | 0.014 |
Variables | HR (95% CI) | P value |
---|---|---|
Obstructive biliary and/or pancreatic duct dilation | 5.819 (1.552–21.810) | 0.009 |
Lymph node metastases | 21.602 (4.193–111.299) | 0.001 |
Portal lesion enhancement ≤ 99.79 HU | 3.018 (1.007–8.454) | 0.036 |